1.1       Background to the Study

            In contemporary societies, cultures develop over time as a result of imprinting the mind through social and religious structures, intellectual and artistic manifestations. Some people become culturally blind as their beliefs and practices make them as strongly ethnocentric as they view their own culture as being superior to others. This ethnic culture is learned from birth through language and socialization and is shared among members of the same culture group. Thus, in the words of Osuala (2000) it includes internal sense and external perception of distinctiveness.

            Cultural beliefs and practices, according to Spector (2004), are the ways of life of people that influence their attitudes, rules, regulations, and their health- seeking behaviours. Our learning and cultural experiences influence not only our behaviour, but also how we view ourselves (i.e. our ‘culture identity’) and the world. Cultures differ from one another in many ways, but one of the most important differences from psychological perspective is the extent to which culture emphasize individualism versus collectivism (Parsons, 1956), In most western or industrialized cultures, emphasis is on personal goal and self-identity based primarily one’s own attributes and achievements. In contrast, many cultures in Asia and Africa have individual goals subordinated to those of the group and personal identity, as defined largely by the ties that bind one to family and other social groups (Passer and Smith, 2001).

            The health needs of culturally inclined societies depend on the meanings they attach to illness and behavioural responses to illness; these are the basic factors influencing the reactions of the public to health programmes. Also, the simplicity of available modern curative measures or the relative availability of such measures may not be sufficient conditions for their adaptation on a large scale. The extent to which modem methods are adopted may still depend on the people’s perception of the causes of ill-health and on their levels of conviction about the efficacy of such methods (Feyisetan and Adeokun, 1998).

            Influence of cultural beliefs and practices on mothers’ adaptive management of diarrhoea has always been of much concern to governments and health practitioners for a very long time. Diarrhoea, as defined by Gupta and Mahajan (2003), is the passage of liquid or watery stools. These liquedified stools are usually passed more than three times a day. According to the World Health Organization Report, diarrhoeal disease is the third leading cause of death among children in developing countries (WH0, 1995). Similarly, in Ethiopia, the Federal Ministry of Health (FMOH, 2005) reported that 20% of child mortality is attributed to diarrhoeal disease. In short, diarrhoeal disease is the major health problem in developing countries.

            A child under five years of age is estimated to suffer from an average episode of diarrhoea per year in Pakistan (Biloo and Ahmed, 1997). Diarrhoea is the leading cause of childhood death in Pakistan (Nielsen, Hoogvorst, Kuradsen, Mudasser, and Van de Hoek, 2001). Several factors likely to contribute to the very high diarrhoeamorbidity and mortality rates include poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices, and inadequate health services.

             The common cause of diarrhoea in children throughout the world is infection of the intestines and it is also common for children in developing countries to have between 3 and 11 episodes of diarrhoea per year per child. The infection of the intestines can cause intestinal losses of fluid and electrolytes which are relatively large and may progress rapidly to cause dehydration. Having multiple and persistent episodes of diarrhoea can cause nutritional deficiencies through loss of water and electrolytes from the body and nutritional consequences, diarrhoea can cause death in children if not treated immediately (WHO, 1992).

            Themost important interventions during the occurrence of diarrhoea are the replacement of fluid losses and continued feeding during the episodes, including increase in catch-up feeding following the episodes (WHO, 2000). However, there is a challenge among mothers in promoting the practice of increased fluid and continuous feeding for diarrhoea management. The common practices concerning perceived cause, types, signs and symptoms of diarrhoea are attributed to one’s beliefs and perception. For example, an ethnographic study done in rural districts of kwazulu — Natal in South Africa on the description of locally perceived diarrhoea types, signs, symptoms, cause and action taken revealed that:

i)          not all conditions of frequent or watery stool were perceived as diarrhoea;
ii)         sign of dehydration were not always attributed to fluid loss;
iii)        medical care and oral rehydration therapy were considered useless in          conditions of   supernatural causation (Kottack, 1994).

In another ethnographic study done in mana district of Ethiopia, it was found out that types of childhood diarrhea and the remedies to be taken varied.  Teething, evil-eye, and other causes were identified for frequent loose stool for which the degree of concern and treatment resorts were varied (Fakadu, 2000).  Because of this, common to numerous societies in the developing world is the co-existence of several medical symptoms, between which people move back and forth in seeking care.  As a result, mothers’ conception about the illness and their expectations about treatment are often at odds with those of physicians.  This is at least one of the reasons why physicians’ advice is not always followed or even understood by mothers.

Therefore, it is the health sector’s responsibility to find effective ways of delivering their interventions in ways that culturally are appropriate for the population.  The fact that diarrhoea episodes as managed by mothers depending on their cultural belief systems on type identifications and cause explanation with little or no medical knowledge showed will be deterrent to looking for common ground of understanding between them and the health sector.  This is so because despite government’s effort to provide health services at highly subsidized rates, the cultural beliefs and practices  hinder people from accepting health services provided at grassroots levels, as their disease etiology and mothers’ adaptive managements are culturally rooted.  Individuals used to pay little or nothing for health services rendered to them until structural adjustment programmes (SAP) was introduced,  and facility treatments now seem to have gone beyond the reach of many people in the village level to the extent that health seeking behaviours of many were altered. 

This made the researcher   deems it fit to investigate why “larger percentage of children in IkotObiodo community” is still subjected to many episodes of  these childhood diseases while treatments are offered  at a low cost that they could afford. The study is carried out to help the health care system solve problems of cultural   beliefs and practices.

1.2       Statement of the Problem

            Diarrhoeal diseases are a major cause of morbidity and mortality among children under five years (0-5 years).  It has been estimated that diarrhea accounts for 28% of deaths in this age group in more than a million deaths in a year (Lucas and Gilles, 2003).  Most of the deaths in diarrhoea are due to frequent passage of loose watery motions.  Prevention of diarrhoea itself is not an easy task and remains a long –term goal to be achieved.

Atueyi (2012) maintained that Nigerian parents lose over one million children annually to preventable killer diseases.  He opined that all the deaths occurred before the age of five and with the gloomy picture, Nigeria still bears one tenth (1/10th) of the world mortality burden.  Atueyi stressed that of the 9 million children that die every year world wide before the age of five, 97 percent of them die in low or middle income countries, and approximately from the poorest and most marginalized communities within those countries.  A child he said, dies every three seconds, while four million of these children die within the first month of their birth.             The former Minister of Health, Dr. Grange in her speech still in the pharmanews argued that even though Nigeria holds the key to Africa’s progress towards the achievement of the Millennium Development Goals (MDGs) 4 and 5 by 2012,  the country is still bedeviled by high infant and maternal mortality rates than the goals seek to address.  If the MDGs 4 and 5, which dwell on the reduction of infant mortality rate, are to be achieved by 2015, Dr. Grange argued, that the annual reduction in infant mortality needs to be at least 10 percent from now until 2015.